Provider Demographics
NPI:1528461472
Name:SEIPEL, MELISSA (LMP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SEIPEL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BLACK LAKE BLVD SW
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1120
Mailing Address - Country:US
Mailing Address - Phone:360-556-4126
Mailing Address - Fax:
Practice Address - Street 1:3021 KAISER RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-556-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60497779172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist